Nursing Elites

1. A client is experiencing preterm labor and has a prescription for 4 doses of dexamethasone 6 mg IM every 12 hours. The available concentration is dexamethasone 10 mg/mL. How many mL of dexamethasone should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use trailing zero.)

• A. 0.6 mL
• B. ---
• C. ---
• D. ---

Correct answer: A

Rationale: Calculation: (6 mg/dose) / (10 mg/mL) = 0.6 mL per dose. The correct answer is 0.6 mL. This calculation is obtained by dividing the dose needed (6 mg) by the concentration available (10 mg/mL). The resulting value is 0.6 mL per dose. Choices B, C, and D are not applicable as the correct answer has been calculated accurately.

2. What causes cystic fibrosis?

• A. Sex-linked abnormality.
• B. Abnormality in the 21st pair of chromosomes.
• C. Recessive gene.
• D. Single segment found only on the Y chromosome.

Correct answer: C

Rationale: Cystic fibrosis is a genetic disorder caused by inheriting two copies of a recessive gene, one from each parent. This means that both parents must carry at least one copy of the faulty gene for a child to inherit the condition. Choice A is incorrect because cystic fibrosis is not linked to the sex chromosomes. Choice B is incorrect as cystic fibrosis is not caused by an abnormality in the 21st pair of chromosomes but by a specific gene mutation. Choice D is also incorrect as cystic fibrosis is not related to the Y chromosome, which is specific to males.

3. A newborn assessment reveals spina bifida occulta. Which maternal factor should the nurse identify as having the greatest impact on the development of this newborn complication?

• A. Tobacco use.
• B. Folic acid deficiency.
• C. Short interval between pregnancies.
• D. Preeclampsia.

Correct answer: B

Rationale: Folic acid deficiency during pregnancy is strongly associated with neural tube defects like spina bifida occulta. Adequate folic acid intake before and during early pregnancy significantly reduces the risk of such complications. Tobacco use (Choice A) is linked to other adverse outcomes but not specifically spina bifida occulta. Short intervals between pregnancies (Choice C) can increase the risk of preterm birth and low birth weight but are not directly linked to spina bifida occulta. Preeclampsia (Choice D) is a hypertensive disorder that poses risks to both the mother and baby but is not the primary factor contributing to spina bifida occulta development.

4. A client is experiencing sore nipples from breastfeeding. Which of the following actions should the nurse take?

• A. Place a snug dressing on the client’s nipple when not breastfeeding
• B. Ensure the newborn’s mouth is wide open before latching to the breast
• C. Encourage the client to limit the newborn’s feeding to 10 minutes on each breast
• D. Instruct the client to begin the feeding with the nipple that is most tender

Correct answer: B

Rationale: Ensuring the newborn's mouth is wide open before latching is crucial for achieving a proper latch, which can help reduce nipple soreness. Placing a snug dressing on the nipple when not breastfeeding (choice A) can lead to further irritation and hinder healing. Encouraging the client to limit the newborn’s feeding to 10 minutes on each breast (choice C) may not be adequate for effective feeding as infants should feed until they are satisfied. Instructing the client to begin feeding with the most tender nipple (choice D) can worsen the soreness as it may not allow the baby to feed effectively.

5. A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman’s stools are dark (greenish-black). What should the nurse’s initial action be?

• A. Perform a guaiac test and record the results.
• B. Recognize the finding as abnormal and report it to the primary health care provider.
• C. Recognize the finding as a normal result of iron therapy.
• D. Check the woman’s next stool to validate the observation.

Correct answer: C

Rationale: The nurse should recognize that dark stools are a common side effect in clients who are taking iron replacement therapy. Dark stools are a known, expected result of iron supplementation and are not indicative of a complication unless other symptoms of GI bleeding are present. A guaiac test would be necessary if there were concerns about gastrointestinal bleeding. Recognizing dark stools as a consequence of iron therapy is an essential nursing assessment skill and does not require immediate reporting. Checking the next stool to confirm the observation is unnecessary as the presence of dark stools in this context is already an expected outcome of iron supplementation.

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